To think the NHS’s biggest problems aren’t management but an ageing population, unrealistic expectations and over-medicalisation?

come back and say that when you are over 80

I’m not in the UK but a family member who is in serious medical decline keeps receiving significant life saving treatments when in any other generation she would have died. She has had sepsis 4 times, from what starts as a very minor infection and declines rapidly, in the last 6 months. Her system is giving out and she will die but she is a very tough cookie so she responds to treatment each time.

Continuous treatment is definitely an expectation from some family members but it is with the medical team too. One doctor spoke of palliative care but the consultant overrode that.

To say her quality of life is atrocious doesn’t begin to describe the situation but on and on and on the merrigoround we go.

This modern obsession with extending life in the aged population without any thought for life quality is really bewildering from this experience. What is the point of it?

@OntheBorder1 of course not, I fully agree with doing everything possible to help premature babies, children, even adults when possible but what I don’t agree on is prolonging the life of a person (who has already lived a long and full life) at massive expense to the NHS.

But all of those problems could be solved with proper management. That's the point of management, to deal effectively with whatever issues arise.

Add to that - no money, no staff, no time and ever increasing demand…it’s completely horrendous to work in at the moment

Politicians like to tell us that the NHS is the “envy of the world”, but has anyone in the world tried to copy it? And the sacred NHS kept being sold as a reason for lockdown going on and on and on and on. “Protect the NHS.”

We have to really think about the implications of an ageing population and the fact the lifespans are being extended in lengthy but not necessarily quality. The elderly present often with a number of co minorities and the NHS is essentially playing wack a mole as a patient sadly degenerates due to aging. One year is night be heart suevery, the next treatment for head and neck cancer then in a couple of years the impact of dementia . The economic and logistic stress on the BUS all adds up.

Those responsible diving the treatment ultimately say they have paid into the system and are entitled to treatment in their old age which is an entirely valid point but we are stretching lives thinly (and expensively) in the later years. There is also the moral case that all patients are treated equally leading to quite invasive procedures for the very trial elderly and I don't know ultimately how wise this is.

We are going to see more doctor strikes in the future and I do think this will precipitate some hard conversations in government in future in terms of having a truly free NHS.

YABU because the biggest issue is the appalling IT structure.

Yup - all of the above. People have ridiculous expectations, and the sooner somevsort of charge is introduced, the better.

It is the age of the population

1. Not enough money to fund a larger aging population when we have so many more treatments now - more money needs to be given to the NHS
2. People who don't look after their own health eg those who drink too much, smoke, take drugs, don't exercise or cause their own medical need on some other way eg choosing to do dangerous sports and getting injured or speeding and crashing their car and those who are obese massively increase demand - should they have to subsidise their treatment or perhaps pay for those issues directly resulting from their lifestyle?
3. Should treatment which isn't 'medically necessary' eg IVF, sex changes, cosmetic surgery etc be funded at the expense of necessary medical treatment to save lives eg cancer treatments?
4. Should the very elderly or infirm have surgery eg hip replacements or heart transplant when they are I likely to live more than a year?

The NHS needs to focus on outcomes. We dont need to test and scan our elderly people for issues they won't be treated for. My MIL has yearly heart scans for a heart issue they will not operate on as she is so frail. She has scans for osteoporosis annually too - it seems the results tell her it's getting worse but there is nothing they can do as she is so frail. Last week she had two scans at two hospitals in a big city on the same day, she was transported by hospital transport from one hospital to the women's hospital for yet another scan. How much is this costing ? And more importantly why is she having scans only to be told there is nothing medically they can do as she is so frail.

Age is nothing remotely resembling a red herring.

age is a red herrring

No it isn't. This isn't to blame older people, most of us will get there but there hasn't been a plan to address the demographics and set reasonable expectations. On visits to hospitals I've seen over 60% of elderly people occupying wards, many with dementia and this isn't the right place for them. Staff having to cope with nursing needs as well as issues relating to dementia, such as trying to leave the bed/ward etc.

A 91 year old day with advanced dementia was admitted as she had breathing issues. Staff were fully occupied trying to keep her oxygen mask on, when she didn't want it. She was highly distressed and wanted a glass of whiskey and to go home. I couldn't help but think hospital wasn't the right place for her and she should have been at home, having her whiskey and perhaps passing peacefully. Drs couldn't discharge her for fear of repercussions but it didn't feel like her best interests to be there.

More staff and less tech? This has to be a joke. I've just been hooked haven't I?! 🎣🤣

But generally the older you get the more you use the NHS. That's a fact. Unless you can provide figures that people in their 50s are heavier users of the NHS than people in their 80s.

The expectations of the British public are wild. People treat the NHS as a one stop shop were they expect all sorts of social issues to be dealt with on admission. People need to start planning for their old age before they get there so they have enough pension, live in appropriate housing, live near a support network etc

Agreed. The problem is the whole thing is built on free at the point of use which means it is so open to abuse and overuse. Other countries with universal healthcare have realistic expectations on their healthcare. Health cards for example. Non emergency use of an ambulance there is a charge. Free prescriptions for life on all prescriptions if you qualify for only one (so you get free insulin for example and then you get free antibiotics under the same exemption) is crazy. Using the A&E as a GP surgery…..We are collectively running the NHS into the ground.

This is not a solution. Yes if you live a heathier lifestyle then you may not get some of the illnesses you listed. But then you live longer and most likely develop other illnesses which require treatment or care.

It's everything! The aging population and the continually progression treatments and technology is an enormous and often overlooked issue. But the NHS is also incredibly inefficient and very wasteful. We have put the NHS on a pedestal and given too much power to the unions. Previous governments have been too frightened to criticise the NHS because the media and the public think they can do no wrong. It is a pleasant surprise to see that it is a labour government who is making moves to shake it up. Let's see if they follow through on their words. But, whilst it can be made way, way better in terms of productivity and quality, it will always be hugely challenged as, quite simply, our tax receipts will never be able to keep pace with the progression of medicine and our aging population.

@godmum there is a huge gap across the NHS between what should happen and what the reality is - millions of pounds of waste/ poor prescribing each month in the UK.... this is just in primary care... https://openprescribing.net/national/england/
https://openprescribing.net/measure/lpzomnibus/
don't get me started on medicines waste in hospital....

Yy to DNR. People have a really poor assumption of what it means- they think they’re trying to kill auntie Doris.

expectations of care as well. My sister’s mil has a brain tumour. When first diagnosed everyone was telling her she must “fight” and asking when she started chemo/was having surgery. In her 70’s she was starting to think their refusal to actively treat it was because she was old. The reality was it was benign, treatment would have likely killed her or worse, left her in a vegetative state. She’s still well now at 85.

in comparison a neighbour was in a similar situation. NHS said you’re well (it was an incidental finding scanning for something else) everything’s stable, chances are it’s benign so we’ll monitor and see. Family were appalled. Paid private for treatment, dead within 4 months from the side effects and interactions with existing issues. After spending the majority of those 4 months on an nhs ward treating the effects of the chemo.

People watch to many US medical dramas and think it’s worth treating everything.

Would you say the same about the amounts spent on very premature babies who once would have died and now don't with medical intervention but often are left with lifelong issues?

So easy just to blame the old.

@LolaLouiseI agree with you totally. IMO people are now living longer than they should, certainly longer than the NHS can cope with. I think sometimes medical intervention has gone too far, maybe that’s why we are seeing so much dementia - because these people would previously have been killed off by other diseases that we can now cure.
It’s a whole other thread but It makes me angry/sad when I see over 80s refusing DNR not only because it’s such an aggressive procedure for people that old but also because it’s basically an attempt to bring back to life a person who has effectively died…

Patient expectation is very frustrating. I recently had a heated debate with a patient who told me that it was outrageous that the NHS was not offering a particular service. The service they wanted (or more accurately, expected) was purely of an administrative nature for convenience. The cost of which would be astronomical and for this reason, it’s not funded because funds are going elsewhere, to actual healthcare. The patient was so aggrieved that something ‘so simple’ couldn’t be funded somewhere along the line, to make lives easier and mansplained to me about this not being acceptable in a privatised sector/industry - yes well sir, I’m not in that industry and this isn’t how it works? I also do think it would be a nice thing to have, but you can’t have it, because it costs too much